Low papp-a - bubs smaller than average - anyone else experience this?

[frog]

Chody, I don't think I had low Papp-a but my placenta is calcifying early, and bubs growth has been restricted. I've been having weekly scans since 32 weeks, just to check on bub, and fortnightly growth scans. I had the steroid shots at 32 weeks as well just in case early delivery was needed. Last Monday we had a growth scan and bub had virtually stopped growing, very minimal growth and has dropped off the percentile chart for abdominal circumference. We are around 15-20th percentile for head circ and biparietal diameter which doc said is fine, but not when abdomen has stopped growing. Baby's estimated weight was 5lb 3oz, after only gaining 250g in the fortnight from last scan. Weights by ultrasound can be way off though. It just sounds like we were going to have a petite baby anyway if all else had gone well.

After those results, dr decided that baby will be born by caesarean tomorrow (baby is frank breech, IUGR, low amniotic fluid and increased umbilical dopplers and technically pre term by one day!), which is 36+6. We have been having CTGs 2-3 times a week as well and baby has still been very active and happy, so I think that has helped the argument for keeping baby in as long as possible.

Ask lots of questions at your appointments, set your mind at ease! The only thing I have found online about this is that every situation truly is unique, my best advice is ask for reassurance if you need it, even if you feel like a nuisance or like you're over reacting, it's no worry to them to give you extra monitoring-better safe than sorry! And my dr told me that one of the most important things was my perception of the baby's movements, if anything changed or there was a decrease I had to report it straight away and go in to L&D. He said their tests are only so good, and if baby gets distressed it will stop moving.

That's just my experience, which will likely be different in the long run to yours, but like others have said, you're still on the charts, which is great news! All the best with it, I'll be interested to see how your next growth scan goes (another thing dr told me-a single growth scan doesn't tell them a whole lot, they need more than one to compare data to make sure baby is still growing).

[Miss_Dee]

My levels were low due to PCOS and my girl measured in the 25th percentile through my pregnancy. The last scan I had around 32 weeks (I think) and she had gone up to the 55th percentile but I'm not sure that measurement was right cause she was in the 25th percentile when she was born. I was told that they expected her to be on the smaller side but she was growing at the right rate so even though she was smallish the whole time, they weren't worried. I just had to have an extra couple of scans to make sure she was growing at the right rate.

I ended up being induced at 41+1. I'm pretty sure if I'd not been induced she wouldn't have come out at all, she seemed pretty cosy in there!

[chody47]

Well I had another scan today. It'll be interesting to hear the report when I see my ob next week. From what I could tell from the quick look at the charts I got, stomach circumference is now less than the 5th percentile. The sonographer said that head circumference was still close to normal. The growth charts seemed to indicate that bubs is still growing, but has dropped down them more, so isn't growing at an average rate. It'll be interesting to hear actual percentiles at my appointment. Hopefully my ob is happy with growth and we can get at least a few more weeks of growing before coming out.

EDIT - (and I know this is totally jumping ahead but just wanted to ask) Does anyone know whether I'm likely to be advised to have a CS if my ob decides bubs needs to come out? Or is an induction more likely? I'm not sure what they advise for bubs that are not growing properly.

[Saffy]

Chody I would say yes about the CS for a number of reasons, mainly a smaller bub has less reserves to cope with labour and would get into distress more easily,is often not head first yet and also to induce a labour earlier than term is often very difficult as your body isn't ready and would most of the time end up a failed induction/ CS.
Often a slow growing baby has a placental issue, so the stress of labour on a not-quite-100% placenta would be too much.

Anyway, good luck and I hope this isn't an issue, but its good to be informed of the possible outcomes, so you don't get shocked if the Dr suggests CS!

You might at least get a few more weeks with regular scans.

[chody47]

Saffy - Your thoughts are along the lines of what I was thinking. I know bubs is head down, but I was wondering about bubs ability to cope with labour. I hope it doesn't come to that, but ultimately I will do whatever my ob recommends as they are the doc and I trust their judgement. I might try and do a bit of reading about CS just to prepare myself 'just in case'. At least that way I am informed.